51. Malignancies of the larynx and hypopharynx.

what are the Benign tumors of the larynx

• Includes: benign laryngeal papillomas, vocal cord polyps/nodules, cysts, mucoceles

what are Benign laryngeal papillomas

• Precancerous or premalignant condition

what is the Etiology of Benign laryngeal papillomas

• Tobacco, alcohol

• HPV 6, 11

what are the Clinical signs of Benign laryngeal papillomas

• Hoarseness

• Inspiratory stridor

• Airway obstruction

how do you diagnose Benign laryngeal papillomas

• History

• Laryngoscopy

  • multiple, reddish-pink wart-like lesions in supraglottic larynx and trachea

• Biopsy

  • due to risk of malignant transformation

what is the treatment of Benign laryngeal papillomas

• Some juvenile papillomas resolve spontaneously at puberty

• Micro-debridement or CO2 laser

• HPV vaccine may prevent/decrease the incidence

what are the Malignancies of the larynx

Include:

• SCC:

• Others:

  • Epithelial tumors: adenocarcinoma, adenoid cystic carcinoma

  • Sof t tissue tumors: fibrosarcomas, chondrosarcomas, rhabdomyosarcomas

  • Lymphoid tumors: lymphoma

what are the locations of SCC in larynx

• 3 sites:

• Supraglottic (40%)

• Glottic (60%)

• Subglottic (<1%)

what is the etiology of SCC in larynx

• HPV 16, 18

• Exogenous carcinogens

  • smoking, alcohol, asbestos, heavy metals

• Carcinogens cause epithelial injury

  • → hyperplasia and/or hyperkeratosis

  • → CIN

  • → penetration of basement membrane

  • → invasion and metastasis

what are the Clinical signs of SCC in larynx

• Hoarseness, dyspnea, dysphagia

• Referred ear pain, globus feeling, hemoptysis

• Neck lumps, loss of body weight

how do you diagnose SCC in larynx

• History and palpation of laryngeal skeleton

• Microlaryngoscopy with biopsy for histology

• Imaging (US, CT, MRI)

what is the treatment of SCC in larynx

• radiation

• surgery

• chemoradiation

what is the prognosis of SCC in larynx

• Glottic malignancies have a better prognosis than the supraglottic or subglottic tumors,

  • Earlier appearance of symptoms, especially hoarseness

  • Limited lymphatic drainage (thus LN metastasis)

What are the malignancies of the hypopharynx

• SCC lol

  • pyriform sinus 60^

  • post cricoid 30%

  • post pharyngeal 10%

What is the etiology of SCC in hypopharynx

• exogenous carcinogens → smoking, alcohol

• same pathomechanism

What are the clinical signs of SCC in hypopharynx

• hoarseness, dyspnea, dysphagia

• referred ear pain, globus feeling, hemoptysis

• neck lumps, loss of body weight

how do you diagnose SCC in hypopharynx

• history and palpation of laryngeal skeleton

• microlaryngoscopy with biopsy for histolofy

• imaging CT

What is the treatment of SCC in hypopharynx

• radiation

• surgery

• chemoradiation

what is the prognosis of SCC in hypopharynx

• Usually diagnosed at an advanced stage, as earlier lesions do not produce symptoms à worse prognosis than SCC of the larynx